Flatline Ethics- When Burnout is a Leadership Failure, with Aimee Ellis

Today, we’re talking about something that most nurses have felt — but few organizations are willing to name honestly.

Burnout.

But what if burnout isn’t about resilience?
What if it isn’t about self-care?
What if it’s actually an ethical issue?

My guest today is Aimee Ellis, nurse executive and author of Flatline Ethics. Aimee argues that when nurses are chronically overwhelmed, morally distressed, and unsupported, that’s not a staffing inconvenience.

That’s an ethical breakdown.

Recently debuting as a Top 10 New Release in Health Policy on Amazon, the book argues that nurse burnout is not a personal weakness — it’s a leadership failure.

If you’ve ever felt moral distress, invisible, or asked to carry the weight of a broken system — this conversation is for you. 

In the five-minute snippet: Grey Sloan Memorial Hospital, Aimee is comin’ for you.

For Aimee's bio, visit my website (link below).

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Transcript

[00:00] Michelle : Today we're talking about something that most nurses have felt but few organizations are willing to name honestly.

[00:07] Burnout.

[00:09] But what if burnout isn't about resilience?

[00:12] What if it isn't about self care?

[00:14] What if it's actually an ethical issue?

[00:18] My guest today is Aimee Ellis,

[00:21] nurse executive and author of Flatline Ethics.

[00:25] Aimee argues that when nurses are chronically overwhelmed,

[00:28] morally distressed and unsupported,

[00:31] that's not a staffing inconvenience,

[00:33] that's an ethical breakdown.

[00:36] Recently debuting as a top 10 new release in health policy on Amazon,

[00:41] the book argues that nurse burnout is not a personal weakness,

[00:46] it's a leadership failure.

[00:48] If you've ever felt moral distress,

[00:51] invisible,

[00:52] or asked to carry the weight of a broken system,

[00:55] this conversation is for you.

[00:58] In the five minute snippet,

[01:01] Grey Sloan Memorial Hospital,

[01:04] Aimee is coming for you.

[01:06] Here is Aimee Ellis.

[01:22] Well, good morning, Aimee. Welcome to the podcast.

[01:26] Aimee: Good morning, Michelle. It's great to be with you this morning.

[01:29] Michelle : It is great to have you this morning where I am, we're having a very mild morning and it's going to be a day in the seventies.

[01:38] What about you? What's, what's on the,

[01:41] what's on the weather report for you?

[01:44] Aimee: It's LA, so it's beautiful every day here and it's been about 80 all week.

[01:49] Michelle : Wow. Yeah, I heard you guys had some pretty warm temperatures last week. Were you in the 90s or something?

[01:58] Aimee: Sunscreen. Sunscreen and beach days all the way.

[02:02] Michelle : All the way,

[02:03] yes.

[02:04] My nephew's in LA and he loves it.

[02:07] Okay. Well,

[02:09] yes, thank you so much for joining me. I was excited when you reached out and so we're just going to get into it.

[02:16] So you are the author of Flatline Ethics- When Burnout is a Leadership Failure.

[02:22] And I will tell you full disclosure, I have not read your book, but I have read many positive reviews from nurses.

[02:31] So, Aimee, why do you think your book resonates so strongly with nurses?

[02:36] Aimee: It's been a resounding theme here on your podcast at times too. I think we're in a really interesting time as professionals,

[02:46] which, by the way, this year,

[02:48] maybe we're not professionals anymore. Who knows?

[02:51] So that has an impact.

[02:54] What I know about nursing is that status quo kept us behind the curtain,

[03:00] like we had some ideas about things we might need to fix. But Covid just really pulled back the curtain and we could just see everything like bare.

[03:08] And we've got some issues that we need to really address as, you know, as leaders,

[03:14] as a profession.

[03:15] And so I think people across the spectrum, whether you're a new grad and you get,

[03:21] kind of caught up in the system for the first time,

[03:24] or you've been a veteran and you've been in the system and you've watched the trajectory of change.

[03:29] I think everywhere I go, people are just, it's the same thing, you know, I'm tired,

[03:35] I don't have the moral resiliency that I used to have, and things have just changed so much.

[03:41] Michelle : I have now talked to quite a few nurses and other medical professionals that echo exactly what you're saying.

[03:50] My career was 36 years and the last two years of it were Covid.

[03:55] I know there were probably some times in my career before COVID that I was feeling a little,

[04:01] I don't know if it was burnt out, but I was feeling a little bit bored maybe, like, is this all there is? So I took some personal responsibility to say why are you feeling this way and what could you do about it?

[04:15] But Covid, like you said, unmasked so much moral injury that nurses had really never seen before,

[04:26] at least in our generation. And it really caused us to sit up and take notice of organizational failure,

[04:35] organizational betrayal,

[04:38] and just our own feelings of moral injury, all of that.

[04:44] So how does shifting burnout from a resilience issue, because you mentioned resilience, and resilience to me is a bad word.

[04:56] It didn't used to be, but Covid changed that because we were kind of force fed that we just needed to be more resilient.

[05:05] But how does shifting burnout from a resilience issue to an ethical issue change the way healthcare organizations should respond?

[05:14] Aimee: Well, you hit it square on when you had said,

[05:19] yeah, it's basically when you view the resilience issue as an individual problem,

[05:26] the prescription is often an individual issue with something like, hey, go get some yoga and have a cup of coffee and take a nap.

[05:34] And we don't see that as a system misalignment and a system failure. That is not just an individualistic experience, but it's experience on the whole. Right?

[05:46] And so one says,

[05:47] let's address this individual person which feels like a failure.

[05:53] The other says,

[05:55] let's address the system which feels like an empowerment.

[05:59] Does that make sense?

[06:00] Michelle : Absolutely. And just those two words,

[06:04] failure and empowerment,

[06:08] totally different connotations, right?

[06:11] And I think as nurses, we're going through that time period and feeling so much angst about everything and wondering why am I feeling this way?

[06:25] Why am I burnt out?

[06:27] This must be something within me that I failed when in all actuality, it was the system failing us.

[06:37] So why do you think healthcare has leaned so heavily on the nurse's individual coping strategies rather than reforming the system?

[06:48] Aimee: I think it takes introspection,

[06:50] and I think you and I both know it's hard for a healthcare system to do that.

[06:55] It gets stuck in its agreements with metrics and its agreements with how it thinks the system should run.

[07:02] And it's pretty risky to pull it apart at the seams and think about how to transformatively think about leadership and how to bring nurses along.

[07:13] Right? Because we have, I mean, we have metrics for everything. Those are the conversations we have as leaders. I talk about that a little bit of my book, and I think we missed the mark there when we're missing the nursing voice at the table to say,

[07:27] look, times are changing and the way the system is built is not keeping up.

[07:32] And we see that on our spreadsheets, we see that on our budgets,

[07:36] we see that in the margins.

[07:38] But we're not listening to the folks at the front line who have the moral authority and the understanding of what the causes to those issues are.

[07:48] Michelle : That's so telling.

[07:51] Let's talk about moral distress.

[07:53] And I think you say in your book that moral distress is a warning signal and not a weakness.

[08:00] Talk more about that Aimee.

[08:01] Aimee: Yeah, I mean, if you think about why we became nurses, you think about our oath, the Nightingale pledge, you think about those days early on in our careers,

[08:14] you know, I come from a place that no one comes to the profession of nursing with any other really real intent other than to help people.

[08:23] I mean, that's our modus operandi.

[08:25] And when we're in a system that is moving so fast, that is so corporate driven, it's corporatized,

[08:33] there's a lot of billing issues. It's driven by quite a bit of capitalism at this point. And in my career, I've seen the change in the trajectory.

[08:46] You take away the soul of the profession itself,

[08:50] and we're just kind of a cog in a wheel. We're moving.

[08:52] You know, I see that, and I experience that with physicians and with nurses. And here's a couple of examples.

[08:58] You know, we move people through the system because we have to quickly, particularly in an inpatient environment.

[09:04] But oftentimes, nurses and physicians know their patients are not ready to move to that next level.

[09:11] But the system forces that conversation to happen with the patient and gives none of those providers the voice or the place to be able to say, wait, this may be the framework, but this is not a cookie cutter situation.

[09:25] And that increases the risk for,

[09:28] you know, healthcare providers to have moral injury because they went into this profession to help and to be, you know, a change in their community.

[09:37] And when you walk away from every shift feeling, you know, defeated or like you could have done more,

[09:42] if only then over time.

[09:45] Take Covid. Covid was an acute disruption to our mental health as healthcare providers, especially in the acute care setting. Take all that away.

[09:57] Just in a normal day to day environment,

[09:59] you know, those injuries,

[10:02] small as they may be, over time,

[10:04] they build up to the point where,

[10:07] a nurse or physician may be thinking, gosh, why do I feel this way? And don't have really the internal ability to say, well,

[10:15] no, actually it's been two years of feeling

[10:19] on a daily basis like the care that I delivered was less than what I could have given.

[10:24] And that's where you see, you know, the biggest risk for moral injury is not that nurses leave, which they are,

[10:32] but it's the silent quitting.

[10:34] It's when they show up to their shift and they sort of finally just put their hands down and surrender to the system and just try to make it through the day because it's too hard to fight it.

[10:46] That's where you find the risk in nursing with moral injury, I think.

[10:50] Michelle : Yeah, that's the really sad part of it is when nurses know how patients should be cared for and their hands are tied in being able to care for them.

[11:04] And you hit on it. I have an episode coming out tomorrow. It's a solo episode that I did on changing nursing culture. Why is it so hard?

[11:13] And you know, one of the things that I talk about in there is that,

[11:18] nurses weren't even built into the hospital model. It was a medical model and nurses were kind of an afterthought.

[11:29] And the other thing is that,

[11:32] hospitals are big business. Like you said,

[11:35] they're huge business. And when productivity becomes the metric that we aspire to,

[11:44] things are going to suffer because we're humans, we're not robots.

[11:49] You know, AI hasn't taken over hospitals yet. AI, robots.

[11:55] Maybe one day. Maybe one day we'll see it, and that'll be a sad day.

[12:03] Well, moral distress becomes normalized, what are the consequences of that?

[12:10] Aimee: So, you know,

[12:11] when it becomes normalized, you see deviation from standard. I talk about that in my book.

[12:17] You show up, you inculcate yourself in a culture where this is just how they've always done it,

[12:24] even though you sort of know in your heart and in your gut, your nursing gut, that's not necessarily the case.

[12:32] And this is true for even physicians,

[12:34] and you inculcate yourself into that culture to the degree that you become numb to survive,

[12:40] and that is what I see. You know, we talk about different facilities have different ways that they try to address cookie cutter issues that they have, like speak up culture and things like that.

[12:53] But it's less of a slogan and a badge that you wear and a thing that you check a box, and it's something that you live.

[12:59] And I think, when you think about.

[13:04] We talk about incident reporting,

[13:06] and we talk about,

[13:08] wow, this Unit's only had 30 incident reports this month. Surely they had more.

[13:13] Well, sure they did.

[13:15] And yet the culture is the underpinning of the issue in terms of why nurses don't feel,

[13:21] A, it's worth the time to put it pen to paper, really,

[13:26] because over time, they've learned change doesn't happen,

[13:30] or B, they've learned that the system punishes the reporter.

[13:37] They punish the messenger and not the message.

[13:39] And so we've got to learn how can we have accountable conversations as leaders. How can we learn to accountably listen?

[13:47] Because that is where you affect that transformational change, you know, in your organization. 

[13:53] And like these consultant check off the boxes, like,

[13:56] pass out the pen,

[13:58] give everybody the notepad and the ink pen, because nurses love pens that say speak up culture. I mean, all that stuff is tchotchke, and it's great, but you gotta live it, and there has to be a dedication to it, you know?

[14:09] Michelle : Yeah, absolutely. And over 36 years,

[14:14] we were always encouraged as nurses.

[14:17] Somebody disrespects you, if somebody talks down to you or does something to a patient that's unsafe to report this.

[14:27] And we did, and it became just so commonplace.

[14:33] Years would pass and that person would still be there, still doing that behavior.

[14:39] Nothing happens to that person.

[14:43] So after a while, you just learn to tolerate it and not report it because you see that nothing's changing.

[14:52] That's really sad.

[14:53] And you know, that's one of the reasons why nursing culture takes so long to change.

[14:59] What should leaders hear when multiple nurses are saying,

[15:05] this assignment is unsafe,

[15:07] this discharge feels premature to me,

[15:11] or this staffing model compromises care?

[15:15] Aimee: It's so hard sometimes as a leader to learn.

[15:20] You know, some folks have it built in and they do it really well and some folks have to learn it, but you've got to lean in and have empathy. You have to learn to listen.

[15:29] You know, it's so easy. And Michelle, I know you've seen this in your career. It's so easy. And sometimes you'll see leaders do this over time that they coach the metric, coach the metric.

[15:41] You know, units having falls, units having, let's say, staffing issues.

[15:46] They're coaching that metric with a hammer.

[15:49] And it's really important to get underneath it and understand why and listen,

[15:55] because otherwise you're just going to be chasing the same metric as a leader, but also your people don't feel seen and you're not leading. I mean, that has been my biggest sort of aha moment in my own career, you know, is that,

[16:09] I mean, metrics are great. As I said earlier in the conversation, they're great, but they're only just indicators that point us to a bigger truth and we have to be open to the bigger truth.

[16:19] And that's always changing. You know, I know we like constancy as humans. We like to say this is going to be our system and this is how it's going to work for the next 10 years.

[16:28] Healthcare absolutely is evolving too quickly to lead that way and we have got to be nimble on our feet. And so a couple of points that I would say to leaders who find theirselves caught in the middle and maybe they want to do a turnaround and maybe they've had those leadership sort of styles before and they're ready for a change.

[16:47] And so the first one would be,

[16:49] tell the truth about your own capacity.

[16:52] Just be honest with your team.

[16:55] If you're having a staffing issue,

[16:57] be real about it. It's kind of like as a parent,

[17:01] your kid wants to buy everything in the store. At some point you need to tell your child, we can't afford everything here, and here's why, here's what we can do, right?

[17:10] And so it's learning to have that kind of dialogue and bring your staff into the conversation with you.

[17:16] I think the other thing is to close the feedback loop.

[17:19] Because, psychologically as you mentioned earlier with the, the safety reports,

[17:26] I could be doing everything in my power as a leader. I could have 20 action items that I'm all over.

[17:33] But if you don't know what I'm doing and I'm not keeping you up to date on my progress, then you don't trust me because it fell into a black hole that you never then heard anything about.

[17:43] Right. So it's really important to keep that communication going.

[17:46] And then third,

[17:47] which is the most important for me is that you have to align your incentives with your values.

[17:54] You have to reward the behavior that you're trying or the culture follows what you are going to reward as a leader.

[18:03] And that's subconscious. So, like, I don't think any leader 

[18:09] that I know of in my time in my colleagues consciously make a decision to reward bad behaviors or to reward,

[18:17] you know, the untoward things in culture that you want to change. But we do that all the time. Sometimes we do that with inaction,

[18:24] And your own behavior. So if I am asking my team for follow up, I have to model that follow up.

[18:31] And that in and of itself is a reward. My own behavior of what I'm asking for is a reward for my team. They understand that and they learn that. So it's not a pizza party.

[18:42] And it's not like if you guys get to zero falls this month, then we're gonna do X, Y, Z. Those things are fun.

[18:49] But it's understanding that it's more morally grounded in how I reflect that reality to look and I have to lead from where I stand,

[18:59] if that makes sense.

[19:01] Michelle : Yes, absolutely.

[19:02] And, you know,

[19:04] like you said, culture follows what is rewarded.

[19:09] And so we have to ask ourselves as a profession, 

[19:14] What behaviors are we rewarding? Right?

[19:17] And if we can change those, then culture will change.

[19:23] You mentioned leaders. We've been talking a lot about leaders and leadership.

[19:27] And I want to talk about leadership kind of from wherever you stand as a nurse,

[19:33] because one of the things you write about is that nurses don't have to wait for a title to lead.

[19:39] So what does leadership look like from the bedside?

[19:43] Aimee: I think this is my favorite topic because all nurses are leaders. We are all leaders.

[19:48] If you look, ancillary staff look to us,

[19:52] the patient is looking to us, not the leaders of the organization. They're looking at the nurses at the bedside to lead them through the experience they're having. 

[20:01] And they are.

[20:03] Nurses are always the integral piece of the care team,

[20:05] they are where sort of everybody sort of collects. So whether it's physical therapy or if it's a physician, we're always sort of the management communicator of that patient's care. And so we're always the leader.

[20:17] So I think a couple of things.

[20:19] One thing that we don't do very well as a profession is we do have a hard time speaking up. We do.

[20:27] We're caregivers by nature.

[20:29] And so it's really hard for us to name our own reality.

[20:32] But I think we have to name reality.

[20:35] We have to say what our limitations are,

[20:37] and we have to be a bit more descriptive and we have to have boundaries. So that's the first thing,

[20:42] and definitely within that is speaking up regarding safety concerns as a profession. For years, we've had a difficult time with this, especially as it relates to,

[20:52] let's say, communications with physicians and such. But I think that is absolutely a leadership sort of standard that we all need to work on. Two, is protect the standards.

[21:04] So you go into a culture and this is the way they've done it.

[21:09] I think it's important and it's a leadership capability that we refuse those deviations from what we know is the standard practice. We have to,

[21:18] particularly post-Covid, things have gotten a bit loose clinically and they never got tied back up.

[21:23] And then third, I think, is to model integrity. You know, you can lead, as you said,

[21:28] every day from where you stand,

[21:30] and just your consistency and your practice is sort of the hallmark of that ability to lead from where you stand,

[21:40] always, always holding ground for the patient, for their safety and then understanding,

[21:47] You don't need positional power to create some kind of moral clarity in your clinical circumstances.

[21:54] You are the authority of the moral clarity. You're the one at the bedside who's taking care of the patient.

[22:00] And so to me,

[22:02] it's not a sound bite. It's true. I believe that nurses at the bedside carry more power than organizational leaders do.

[22:11] And it's my hope, and it was my hope in writing this book, that more nurses at the bedside would read than leaders.

[22:17] Because it's my dream and hope that moving forward in this fast changing culture of healthcare, that nurses begin to rise up a bit more.

[22:25] You know, remember during COVID as we mentioned earlier,

[22:28] you didn't really see nurses out there.

[22:31] We all saw Dr. Fauci, we all saw the physicians, but we didn't see any nurses who were asked about their professional perspective on what to do next, we were not at the table.

[22:42] And so I think nurses at the bedside and their voices are what's going to put that, push that forward over the next 10 years.

[22:49] Less than folks who have the formal titles.

[22:53] Michelle : I think your message is so important, Aimee, and I really hope nurses listen and take note, because I have felt throughout my career that nurses at the bedside actually hold the most power, as you said,

[23:05] and they don't realize it. I think they are beginning to realize it. And as you said, Covid really helped with that advocacy,

[23:16] but it's been a real hard time trying to get them to see that they are leaders. You know, I've heard from nurses. I've said, why don't you advocate for this patient?

[23:27] You know, why don't you call the social worker? And no, I'm just a nurse.

[23:31] They're not going to listen to me.

[23:33] I'm like, don't worry that you're just a nurse because you hold so much power. You're with this patient for 12 hours a day,

[23:41] you know, multiple days. You see the ins and outs.

[23:47] You know what's going on, and you are their best advocate. And whether that's talking to another professional like a physician or family, as you said,

[23:58] the patient is looking for someone to lead them through the experience,

[24:04] exactly as you said. And I think when we start seeing it through that lens,

[24:10] that nurses are going to see their real power.

[24:13] So for nurses who feel powerless or cynical, what is one place that they can begin reclaiming their leadership within their own practice?

[24:25] Aimee: Today is the first day to start.

[24:27] It's a day for us all, I think, to realize and wake up to the fact that the nurse at the bedside who was there, as you said, for 12 hours,

[24:36] is the expert in what that patient is needing and their care.

[24:40] And I think over the years,

[24:43] for many reasons,

[24:45] that's been eroded and that has created some sense of distance in the professional accountability of things. And also the cynicism that you mentioned, I see that often.

[24:56] And some of that cynicism really isn't cynicism. It's just, again, moral injury and just tired, you know, it's just some moral quitting of just, you know, you showing up.

[25:06] You continue to do what you're doing,

[25:08] but you just leave behind what we all carried into this profession, which was this idea that we were all gonna make a big impact.

[25:18] You know, that gets eroded over time. And so I think today is the first day to start and to look at your clinical environment with a different set of eyes instead of through a lens of passivity.

[25:32] Look at your system.

[25:34] If your system is broken,

[25:36] where is your system broken?

[25:38] If your system is missing the mark,

[25:42] where and how do you put words to that in a non-emotional way? How can you separate yourself from the emotion of it? Because we all feel emotion. We love our patients, we care about our profession.

[25:54] But how can you look at it almost from a third party, neutralized perspective and say,

[25:59] okay, so this is what,

[26:01] This is where things are.

[26:04] This is what's missing in the system.

[26:06] How can you be part of the answer to how that issue or that broken part in your system gets resolved?

[26:18] Again, that doesn't come from the institutional power that comes from you at the bedside and your knowledge and expertise and your care and passion.

[26:31] And I know a lot of people listen to that. Like, I almost can hear it in my mind. I know a lot of people will listen to that and say, yeah, but you don't work in my system, Aimee,

[26:40] No, I've seen it all.

[26:42] But again, I will say that if you're coming from a place of neutrality,

[26:46] but also that heart space, that all we nurses do what's best for the patient, and we keep that in the forefront of all the conversations that we have,

[26:56] and we look at things strategically, there's always something that we can do to improve the system.

[27:00] And collectively, there are far more bedside nurses than there are formalized leaders.

[27:07] And it's really important that I would also say that you have small groups and you get together whether you have UBTs in your areas or whether you have, you know, work groups, it's really important to get together in numbers because those numbers matter.

[27:22] And not only do they matter from a power position, but they also matter from the position of, I may have a great idea, but if 10 of us come to the table,

[27:31] we have 10 great ideas that we can offer.

[27:34] Michelle : Yeah. And I love that you reframed it as,

[27:38] the nurse at the bedside is the expert.

[27:41] And wouldn't that be amazing if nurses could see themselves as expert? I think that would be so empowering and it would really go far in changing the system.

[27:52] Aimee: Yeah.

[27:54] Michelle : Okay, so let's flip the lens. If burnout is an ethical failure of leadership, what do leaders need to do differently?

[28:03] Aimee: Well, you know, we touched on burnout having been sort of discussed in the framework of resilience. And I think we need to ditch that philosophy. It's old,

[28:15] old news and we need to really start to think about burnout as a secondary symptom,

[28:21] that something is wrong with the system.

[28:26] So we would never, let's say, so that we're amongst friends here on a nursing podcast, we would never treat a heart attack with the symptomatology of like, let's say nausea, vomiting and diaphoresis.

[28:39] We would never say the nausea, vomiting is the problem.

[28:42] We would say we're curious enough to understand that that's a symptom.

[28:46] What is that then leading us to, to understand is the problem. What is the root?

[28:51] And I think the root is that the system isn't built for the kind of care that we intend for nurses to provide.

[29:01] There's always going to be friction because we're saying efficiency and we're saying productivity in ways that in my almost 30 years of a career, I've never,

[29:15] over the past five years, I've seen that exacerbate to a place that it's just, it blows me away the amount of emphasis we put on productivity and efficiency.

[29:24] However, the system itself isn't designed for us to provide the care in that way.

[29:30] And so what we do is we punish the provider for not providing the care that's expected,

[29:37] meeting the metric, whatever,

[29:39] other than saying,

[29:41] hey, provider, I keep seeing this over and over and over again.

[29:44] Talk to me about what you think the issues may be.

[29:47] And oftentimes, again, I'll use the example of discharge time. We love to talk about, you know, discharge time. Order to discharge needs to be at least 60 minutes, you know, bare minimum.

[30:01] But if you're not meeting that metric, there are so many things that we need to sit down and we need to understand about the community that we serve.

[30:09] What's the complexity of the patient's discharge,

[30:12] how much teaching is necessary,

[30:14] what resources might we not have that we might need to provide to make sure that those nurses are productive and that those nurses feel good about the care that they're providing?

[30:24] Because I'll tell you, Michelle, everybody knows what it feels like to do a 60 minute discharge.

[30:29] And you know, that's tough. It's tough. And when you're the nurse and you're sending that patient out the door, there is a bit of moral injury when you know, they're not ready and you didn't give them every single thing that they needed to be successful when they went home.

[30:43] And so I use that example just as a as just a way to say that's one area in our system that we need to address the brokenness in the system and not the person.

[30:55] And in fact,

[30:56] we need to celebrate our bedside providers to say what a great job you're doing,

[31:02] how amazing it is that we can have this conversation and have them feel like they're sort of at the table designing the plan forward instead of, you know, just we hand down these edicts from upon high.

[31:16] So, you know, that's how I think leaders need to shift their thinking is that we, it's very difficult for us to solve problems that we're not involved in the care daily.

[31:27] We can't solve those problems without having those folks at the table.

[31:31] Michelle : You know, I've seen a lot of leaders over the years burnout.

[31:37] And a lot of them were nurses that were bedside nurses. They started out and somebody saw their leadership skills and said, I think you would make a good manager.

[31:47] And you know, it's a lot different managing patients than it is managing,

[31:53] you know, people or employees. Right.

[31:56] And so these nurses would go into these positions and within two, three years be totally burnt out and leave.

[32:07] And from our standpoint, seeing our colleague leave the bedside, become a manager and then totally burn out and want nothing to do with nursing,

[32:20] it was very distressing because we,

[32:22] you know, we all said, wow, she's such a good nurse.

[32:26] But they totally wrecked her by making her a manager.

[32:32] You know, what are your thoughts on that?

[32:34] How do leaders stop themselves from burning out?

[32:39] Aimee: Gosh, I mean, I could not agree with you more. I have, I mean, this is just a pattern that I've seen repeat on repeat for years.

[32:47] I think the issue is that we assume that,

[32:51] that you take somebody who's an excellent clinician and you can put them in a leadership role and in a system that is not designed to give them the business acumen.

[33:04] It's not designed to give them the skills, the soft people skills that you need to lead people, particularly when it's in a union environment and you see them with their clinical heart torn between this administrative life and this clinical role that still they're so very much tied into have spent for years.

[33:29] And I think the answer to that is,

[33:32] you know, organizations have to have leadership development that is not again, a box checker.

[33:42] Like you don't just go and say this is how you learn to use the software and this is how you move through payroll,

[33:48] but there has to be time spent in coaching, mentoring, classes on soft people skills,

[33:55] understanding how to manage budgets. I mean, we assume that a manager who's a great clinician will just automatically understand how to assume,

[34:07] a unit budget and maintain its margins. Right.

[34:11] And that is just not accurate.

[34:13] And so what ends up happening is they get in these roles,

[34:16] they get this training for the software they're going to use,

[34:20] maybe a couple of days with HR on how to move through, 

[34:23] corrective action processes.

[34:26] No other formalized training on anything with no mentor,

[34:30] with a list full of metrics that they need to hold together and staff who they're still very much connected to,

[34:39] who they understand how unrealistic it is to meet the gap between reality and paper.

[34:49] And so my answer to that, in short, is you gotta have real development,

[34:56] and that real development is not all didactic. You have to have mentorship. You have to have somebody own that person's career trajectory.

[35:05] And it has to be more than just a quick email a week like, hey, how you doing? Did you get your payroll done? Xyz? It needs to be, what are you thinking?

[35:13] What are you feeling? Where are your pain points with your staff? How is your transition from a clinician on the floor to management?

[35:22] You know, where's the rub there? Where are you getting stuck?

[35:27] It's something that everywhere that I've been, it's had to be developed.

[35:31] It's not there.

[35:33] And I find that oftentimes it's not because even there's a realization that there's a gap there.

[35:42] It's that those leaders don't have those skills to be able to do those things.

[35:49] At my director level,

[35:51] C and E level and up,

[35:53] you know, they don't have the skills to be able to sit down and say, hey, Michelle,

[35:57] how are you doing? Really talk to me. Let's talk about this. It's all metrics and it's.

[36:03] Let's keep up.

[36:05] Michelle : Yeah. I think some of the most successful managers that I've seen that came from the bench side are those ones that had mentors and that spent time with them,

[36:16] as you said, not just for all those metrics, but more about how are you doing when you see that your staff is hurting either personally or professionally. How are you approaching that?

[36:30] You know, how are you disconnecting from your staff as friends?

[36:37] Because I've had a lot of friends that have gone into management, and then we're told by upper management that you could no longer be friends with, with these people because you used to be one of them,

[36:49] but now you're their superior.

[36:52] And I know that was really hard, a hard transition for many of the managers to make.

[36:58] But I think you're right on with the professional development part.

[37:03] The managers that I saw that burnt out are the ones that got absolutely no training. They went right from the bedside to management,

[37:12] doing budgets, doing schedules,

[37:14] trying to make all those metrics. And, you know,

[37:18] they really tried for a couple years, but they ended up hating it and saying this isn't what it was going to be.

[37:25] Aimee: It's a real failure,

[37:27] even the smallest of things, which is not a small thing. But to sit someone down and say, do you know how to have a difficult conversation?

[37:35] Not only do you know how to have a difficult conversation, but let me tell you how you're going to feel after the conversation happens.

[37:42] Here's your emotional boundary with that.

[37:45] Here's some things maybe you should watch for. That may not be normal if you're feeling those things,

[37:52] you know, because it is a big deal.

[37:54] We at the bedside, we're caregivers, and then we move into leadership. And you do sometimes have to have difficult conversations, not just, you know, to your employees,

[38:05] but laterally and above.

[38:07] How do you do that? And how do you do that in a way that you can maintain your sanity and your sense of self and not.

[38:16] Not internalize, you know, the weight of those conversations?

[38:22] Michelle : And those are absolutely the soft skills. Right.

[38:27] We all need. And we all need to foster.

[38:30] Okay, well, what would you say to the nurse listening right now who feels exhausted but still deeply cares?

[38:38] Aimee: I would say that you are the future of this profession and that we see you.

[38:51] I understand you're very sane and that you are cherished because this is a time period that you nor I in our career ever had to go through.

[39:05] You know, these. The problems that they're facing now are new problems.

[39:09] The issues. I mean, you mentioned AI earlier. That's not a problem, but it's a new thing. Right?

[39:15] They're on the coattails of COVID and what that did clinically to, you know, the skills of the folks who we see graduating nursing school, even today,

[39:24] we're still recovering from that. And so you are in a unique position that historically I've never seen in my career.

[39:32] And your exhaustion and your angst is valid, but we need you.

[39:38] And so what I hope we can do for you a bit more honoring is that we can have conversations centered around you a bit more and that we can see those more and more often around how we care for you.

[39:51] How do we care for the caregiver? And I hope that you, as the nurse, will speak up and tell us how we can care for you,

[39:58] how can we care for you? And where.

[40:01] Where are you hurting?

[40:02] What makes you tired?

[40:04] And I hope that you'll trust us to listen and to take that information and to actually do something effectual with it.

[40:12] Michelle : Aimee, you're using all my favorite words.

[40:16] You said cherished, and I absolutely love that word and what it connotates.

[40:22] Imagine if every nurse felt cherished by their organization,

[40:28] by their peers, by their managers.

[40:31] Imagine if they cherished themselves.

[40:34] Right. How things would change.

[40:37] And I absolutely love your message to nurses.

[40:40] Before we close, I want to know about TAE Associates & Co. Do you want to talk about that?

[40:48] Aimee: We consult with nurse leaders specifically. Specifically, you know, executive suite nurses,

[40:55] chief nurses, executives,

[40:57] and we talk a lot about what we talked about today.

[41:00] You wouldn't believe the amount of folks who have some of the concerns and some of the fears,

[41:07] some of the exhaustion that we've talked about today. It's very prevalent out there.

[41:14] A lot of folks feel alone in it,

[41:16] Nurse executives don't feel like they have a lot of places they can go to be open and vulnerable about what they don't know or what they're not doing well.

[41:28] And so we help with that.

[41:30] We also help nurse executives with their budgets,

[41:33] understanding that ACA has impacted their margins.

[41:38] Their margins were like, this thin, and now they're this thin. And so we try to figure out how to keep hospitals open, particularly in rural communities. And so, you know, if you're struggling and you're a smaller rural community hospital, reach out to us, and we'd be happy to help you pro bono.

[41:53] Our whole mission right now is just to keep the doors open, keep the lights on, and keep those nurses feeling like they matter and they're valued.

[42:03] And if we can prop up those executives and those nurse leaders to give them the tools that they need so that they can pass that love and that sort of gratitude on down, what we know happens, it always makes it to the patient.

[42:16] Imagine, as you said,

[42:18] if the nurse feels cherished,

[42:21] how does the patient in the community feel?

[42:23] And that's kind of the whole point.

[42:25] Michelle : Yeah, absolutely. Trickles down. Right.

[42:29] And, you know,

[42:31] so important, so important for those rural hospitals to stay open and what a phenomenal service that you provide through your company. That's amazing,

[42:42] Aimee, I have gotten so many great guests from other guests who recommended them. So I know this is putting you on the spot,

[42:51] but is there someone you recommend as a guest on this podcast?

[42:55] Aimee: Just one person? Oh, my goodness. My path has led me to so many places. Um, I would have to spend some time, Michelle, and think.

[43:05] Michelle : You can, you can. I know it's an on the spot question, but definitely think about it and let me know what you think.

[43:12] Aimee: I would have to drop it down to five for you. Okay.

[43:15] Michelle : I'm sure you know a lot of people. Well, Aimee, where can we find you and where can we find your book?

[43:23] Aimee: Yeah, so I'm on LinkedIn. I'm on LinkedIn is Aimee Ellis.

[43:28] My book is on Amazon right now. It'll be on Audible next week for those of you guys who don't have time to read on those 12 hour shifts and you want to listen in the car on the commute and periodically I make it available for free just because,

[43:45] I think the message in the book is more important than the purpose of the book. And so just to get it out there has been important to me.

[43:55] Michelle : That's fantastic. Thank you so much for sharing that.

[43:59] Well, wow, this has been a really great conversation, Aimee. I was looking forward to it. I said as when you reached out,

[44:08] I thought, wow, you're really interesting and I really need to hear what you have to say. And nurses need to hear what you have to say. And you've certainly brought some really deep messages that they can reflect on.

[44:23] So I thank you so much for that.

[44:25] Aimee: It's been great. Michelle, thanks for all that you do.

[44:29] Michelle : Thank you.

[44:31] Well, we're at the end, so we're at the last five minutes, Aimee. And if you have heard any episodes of the Conversing Nurse Podcast, you know, at the end we just play this little game called the five minute Snippet.

[44:43] And it's just a chance for our audience to see the off duty side of Aimee Ellis.

[44:51] So are you ready to play?

[44:53] Aimee: Let's go. I'm ready.

[45:34] Michelle: Okay, what healthcare buzzword would you retire permanently?

[45:40] Aimee: Burnout.

[45:43] Michelle : Love it. Love it. Yeah, let's get rid of that. Okay, if Flatline Ethics had a soundtrack, what would the opening song be?

[45:54] Aimee: Oh, something moody and depressing.

[46:00] Michelle : Oh, wow. Okay. Something really intense and dramatic.

[46:07] Aimee: Intense. Yep. Okay.

[46:08] Michelle: Okay, this is a new game we're playing. It's called Three Words. I'm going to give you three words, and you're going to tell me which one you instantly connect with and why.

[46:20] All right, you ready?

[46:23] Guinea pig, Lizard, Dolphin.

[46:27] Aimee: Dolphin.

[46:28] Michelle : Dolphin. Why? Because you live in LA, near the beach or what?

[46:32] Aimee: They're so adorable. Look how cute.

[46:36] Michelle : They are cute. And they're very smart. That's right, very smart. Okay, what fictional hospital needs the most ethical reform? 

[46:47] Aimee: Okay, I've got this. Tell me, what is the name of the hospital in Grey's Anatomy?

[46:53] Michelle : Oh, gosh, I watched that too, and

[46:57] Aimee: I don't remember that hospital name. Is that is the name? Yes. They have some issues.

[47:04] Michelle : To put it mildly. I love that, they have some issues.

[47:09] That's great. Okay, we need some ethical reform there.

[47:13] Okay, Aimee, we're in your house and there's a picture on the wall of your favorite travel destination.

[47:19] Where is it and who is in the picture?

[47:23] Aimee: Oh, so it's.

[47:25] It's going to be Hawaii.

[47:27] And who is in the picture would be my team that used to work for me there because,

[47:39] Everybody has an experience in their career to be able to make heart connections.

[47:44] They were my little heart family.

[47:47] So I see them and I see a malasada and

[47:52] Yeah, and a dolphin.

[47:54] Michelle : Beautiful. Love it. Okay. If I weren't a nurse, I would be blank.

[48:02] Aimee: If I weren't a nurse, I would be, I think, an artist.

[48:07] Michelle : An artist. Okay. Yeah, I bet you already are an artist.

[48:11] Aimee: Who has time to be an artist and a nurse? But if I weren't a nurse, I would be an artist.

[48:19] Michelle : Awesome. I'm talking to the

[48:21] famous Nicole Cromwell in a couple of weeks. She was on my podcast a couple years ago, an amazing artist in Carmel by the Sea.

[48:31] She was a Stanford nurse, and she went through burnout and she started painting,

[48:38] and now she does it full time.  So we're gonna see what she's up to. But that's awesome.

[48:43] Okay, last question.

[48:46] What is one piece of advice you would give yourself as a baby nurse?

[48:52] Aimee: Oh, my gosh. As a baby nurse. Poor Aimee baby nurse.

[48:56] Laugh at your mistakes,

[48:58] not at your bedside mistakes, but just laugh at your mistakes and allow yourself to learn.

[49:04] Didn't we all think we needed to know it all in, like, the first day? How stressful.

[49:09] Michelle : Big mistake, right?

[49:11] Aimee: Hubris. You learn when you graduate nursing school, you don't know anything for five years. And that's what I would have told my former self.

[49:19] Michelle : I love it. Thank you, Aimee, again. It's just been wonderful.

[49:24] Aimee: Thank you, Michelle.

[49:25] Michelle : Yes. Have a great rest of your day.

[49:27] Aimee: Thanks.